Sliding hiatal hernia (HH) is not a disease but is a normal consequence of aging. The gap between the crura of the diaphragm, through which the esophagus passes, tends to enlarge with age, and up to 70% of the population over the age of 70 has hiatal hernias of this sort. In some patients that suffer from Gastro Esophageal Reflux Disease (GERD), the HH slides into the chest, thus, GERD is considered to be caused by the HH. Therefore, in a surgical procedures (laparoscopically or open fundoplication) for such patients, the HH will also be corrected.
In normal breathing, the air moves into the lungs because the pressure in the chest is negative, consequently, the pressure in the abdominal cavity is higher than the pressure in the chest. When the hiatus is enlarged, the negative pressure inside the chest pulls the stomach up through the gap each time the person takes a breath. When the person exhales, if he/she is lying down, the stomach may stay up; but, if he/she is standing, it is pulled down by gravity and slides back down.
When trying to perform a medical procedure involving the stomach or esophagus, e.g. a fundoplication, surgical treatment of morbid obesity, correction of a hiatal hernia, or removal of part or parts of the stomach, on a patient who is breathing spontaneously, and is lying supine, a NH often causes a problem which must be dealt with by returning the stomach to its correct anatomical position beneath the diaphragm and keeping it there during the course of the procedure and thereafter.
In U.S. Pat. No. 7,156,863 by the same applicant, the description of which, including publications referenced therein, is incorporated herein by reference, is described an endoscopic method of performing a fundoplication for the treatment of gastroesophageal reflux disease (GERD). In this procedure the wall of the fundus of the stomach is pushed up against the esophagus and is attached to it. The preferred place to attach the tissue of the fundus to that of the esophagus is about 3-5 cm above the junction between the esophagus and the stomach, i.e. the gastroesophageal junction or Z-line. In the case of a patient with HH, this might not be possible unless some way is found to keep the stomach from being pulled up through the hiatus as the patient breathes.
Many different ways for accomplishing this by grabbing the tissue of the stomach or esophagus or both and pulling the grabbed tissue to the desired position are known in the art. For example WO 2007/022029 describes a device used to create a gastroesophageal flap restoration. The device has a plurality of orifices distributed about the outer surface of a part of the longitudinal insertion member when the insertion member is inserted into the esophagus to the desired depth relative to the Z-line, vacuum is applied through the orifices to hold the inner wall of the esophagus to the outside of the insertion member. The insertion member is then pushed downward to correct the hernia and the procedure is then carried out.
It is a purpose of the present invention to provide a simple, safe method of preventing the junction of the stomach and the esophagus to slide into the chest in patients with HH during the performance of surgical procedures carried out on the stomach or esophagus.
Further purposes and advantages of this invention will appear as the description proceeds.